Mental Health Aids. Spring 2011. - Substance Abuse and Mental ...

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ceptions of religious stress-related growth. Interventions that focus on strengthening spiritual components of the self have been successful in the treatment of addiction, and have been demonstrated to be associated with decreased HIV risk behavior (Margolin, Beitel, Schuman- Olivier, & Avants, 2006[; summarized in the Winter 2007 issue of mental health AIDS]). And (Tool Box -- continued from Page 5) ing the health care worker shortages impeding scaling up of ART [antiretroviral therapy] programs in resourceconstrained settings. . . . The World Health Organization (WHO) guidelines advocate task-shifting from physicians and nurses to community health workers, including [people living with HIV/ AIDS], to provide HIV services at the community level” (Selke et al., 2010, p. 483). “With the shortage of health care providers [in low- to middle-income countries], task sharing and shifting becomes essential in the delivery of services and care” (Relf et al., 2011, p. e16), including the provision of mental health services. As an example, Patel et al. (2010) report on “the effectiveness of an intervention led by lay health counsellors in primary care settings to improve outcomes” (p. 2086) of persons with depressive and anxiety disorders in Goa, India. “The collaborative stepped-care intervention offered case management and psychosocial interventions, provided by a trained lay health counsellor, supplemented by antidepressant drugs by the primary care physician and supervision by a mental health specialist” (p. 2086); this intervention was compared to care as usual in a cluster randomized trial in which 12 public and 12 private facilities were randomized equally between the intervention and control conditions. The investigators found that study participants with confirmed depressive and anxiety disorders “in the intervention group were more likely to have recovered at 6 months than were those in the control group. . . . The intervention had strong evidence of an effect in public facility attenders . . . but no evidence for an effect in private facility attenders” third, these data suggest the importance of community-level interventions that educate religious institutions about the transgender community. Improving the ability of religious beliefs and behaviors to act as facilitators of risk reduction – rather than as barriers to it – is critical to the long-term health and well-being of transgender women. (pp. 1141-1142) (p. 2086). According to Patel and colleagues, these findings “indicate the effectiveness of a lay health counsellorled collaborative stepped-care intervention for common mental disorders in public primary health-care facility attenders in India. This evidence should be used to improve services for common mental disorders in settings for which mental health professionals are scarce” (p. 2094). Task-shifting is not confined to the developing world. In the United States as well, task-shifting in the delivery of HIVrelated services has been implemented as a cost-cutting measure. As readers may recall, task-shifting of HIV-related mental/behavioral health intervention activities to paraprofessional counselors (Dilley et al., 2007; highlighted in the Summer 2007 issue of mental health AIDS) and peer outreach workers (Naar-King, Outlaw, Green-Jones, Wright, & Parsons, 2009; highlighted in the Fall 2009 issue of mental health AIDS) has been evaluated favorably. Peering into the Future Returning to the study on TAP (see p. 5), in which interventions were delivered by HIV-positive MSM peer advocates, McKirnan and colleagues (2010) “randomized 313 HIV-positive MSM to TAP or standard care. HIV transmission risk was assessed at baseline, 6 months, and 12 months (251 participants completed all study waves)” (p. 952). __________ 2 2 “At study completion,” the investigators found that “TAP participants reported greater transmission risk reduction than did those re- Although Ross (2010) stresses the importance of biomedical outcomes when quantifying the impact of HIV prevention interventions, measures of self-reported sexual behavior continue to be utilized much more frequently by investigators. Expanding on an earlier study (Otto- Salaj et al., 2008), summarized in the Fall 2008 issue of mental health AIDS, Otto-Salaj et al. (2010) described “responses of 172 single heterosexual African American men, ages 18 to 35 [years], to condom negotiation attempts. Strategies used included reward, coercive, legitimate, expert, referent, and informational strategies, based on Raven’s (1992) influence ceiving standard care. . . . Transmission risk among TAP participants decreased from 34% at baseline to about 20% at both 6 and 12 months. Transmission risk ranged from 23% to 25% among comparison participants” (p. 952). Expanding on these findings, McKirnan and colleagues suggest that this “counseling intervention for sexual safety and general coping among MSM infected with HIV” (p. 953) provided promising evidence that a peer-led, computerized, and tailored intervention for HIV-positive MSM may reduce HIV transmission behaviors. Intervention effects were partially mediated by a decrease in drug abuse and an increase in selfefficacy for sexual safety, suggesting two important foci for further development of the intervention. These effects were not simply a matter of lessened overall sexual activity and, by being more pronounced for actual transmission risk, suggested that participants were specifically modifying their most risky behaviors. (p. 959) The developers acknowledge that the resources . . . devoted to training and supervision [within this program] may exceed those available in many community or primary care settings. This may limit potential dissemination. However, the computer format can be easily disseminated and tailored to specific settings or populations . . ., and the counseling approaches . . . used are standard in any clinical or counseling psychology training program. Thus, university or medical school collaborations may provide a mechanism for pro- Page 6---------------------------------------------mental health AIDS, Volume 12(3), Spring 2011
model. 1 1 The purpose was (a) to iden- __________ tify strategies influencing participant Otto-Salaj and colleagues (2008) describe the Power/Interaction Model of Interpersonal Influence (Raven, 1992) as follows: “Raven proposes six bases of power from which people derive strategies attempting to influence the behavior of others: (a) reward; (b) coercion; (c) legitimate; (d) expert; (e) referent; and (f) information. According to Raven, coercive and reward power can refer to real physical threats and tangible rewards, but they also can include personal rejection or approval. Legitimate power is derived from the structural gram implementation in even resource-poor community settings. Further, the National Institutes of Health, the CDC, and a variety of private funding agencies emphasize “technology transfer” or “capacity building” as core funding areas. (p. 960) McKirnan and colleagues add that they attempted to integrate a treatment advocate session with each primary care visit[, but] . . . found this approach to take substantial clinic cooperation, and many men had moved toward a biannual or even annual primary care visit schedule, which may be too sparse for HIV prevention needs. As a consequence, most follow-up visits were “free-standing” rather than part of a primary care visit, and [the investigators] could not test the efficacy of true integration of prevention into primary care. Although primary care is an important venue for prevention, community recruitment and followup may be important adjuncts for broader scale secondary prevention. (p. 960) Although the investigators appropriately point up “limitations both to [the] findings and, potentially, to this intervention approach” (p. 960), they conclude that “TAP reduced transmission risk among HIV-positive MSM, although results are modest. Many participants and peer advocates commented favorably on the computer structure of the program. [McKirnan and colleagues] feel that the key elements of TAP – computerbased and individually tailored session content, delivered by peers, in the primary care setting – warrant further exploration” (p. 952). acquiescence to request and (b) to identify predictors of participant compliance/refusal to comply with negotiation attempts” (p. 539). In this study, __________ relationship between the influencing agent and the target; the agent may implicitly or explicitly communicate that she or he has a ‘right’ to ask the target to engage in some behavior, and that the target has an obligation to comply. Expert power is acting on the assumption that the power-holder is ‘correct,’ while referent power refers to engaging in a behavior References Abdool Karim, Q., Abdool Karim, S.S., Frohlich, J.A., Grobler, A.C., Baxter, C., Mansoor, L.E., Kharsany, A.B., Sibeko, S., Mlisana, K.P., Omar, Z., Gengiah, T.N., Maarschalk, S., Arulappan, N., Mlotshwa, M., Morris, L., & Taylor D. (2010). Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science, 329(5996), 1168-1174. Dilley, J.W., Woods, W.J., Loeb, L., Nelson, K., Sheon, N., Mullan, J., Adler, B., Chen, S., & McFarland, W. (2007). Brief cognitive counseling with HIV testing to reduce sexual risk among men who have sex with men: Results from a randomized controlled trial using paraprofessional counselors. Journal of Acquired Immune Deficiency Syndromes, 44(5), 569-577. Grant, R.M., Lama, J.R., Anderson, P.L., McMahan, V., Liu, A.Y., Vargas, L., Goicochea, P., Casapía, M., Guanira-Carranza, J.V., Ramirez-Cardich, M.E., Montoya-Herrera, O., Fernández, T., Veloso, V.G., Buchbinder, S.P., Chariyalertsak, S., Schechter, M., Bekker, L.-G., Mayer, K.H., Kallás, E.G., Amico, K.R., Mulligan, K., Bushman, L.R., Hance, R.J., Ganoza, C., Defechereux, P., Postle, B., Wang, F., McConnell, J.J., Zheng, J.-H., Lee, J., Rooney, J.F., Jaffe, H.S., Martinez, A.I., Burns, D.N., & Glidden, D.V. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363(27), 2587-2599. Hankins, C.A., & de Zalduondo, B.O. (2010). Combination prevention: A deeper understanding of effective HIV prevention. AIDS, 24(Suppl. 4), S70-S80. Hayes, R., Kapiga, S., Padian, N., McCormack, S., & Wasserheit, J. (2010). HIV prevention research: Taking stock and the way forward. AIDS, 24(Suppl. 4), S81- S92. McKirnan, D.J., Tolou-Shams, M., & Courtenay-Quirk, C. (2010). The Treatment Advocacy Program: A randomized controlled trial of a peer-led safer sex intervention for HIV-infected men who have sex with men. Journal of Consulting & Clinical Psychol- participants viewed six videotape segments showing an actress, portrayed in silhouette, speaking to the viewer as a “steady partner.” After each segment, participants completed measures of request compliance, positive and __________ because of a sense of connection or relationship with the influencing agent. Finally, informational power is based on the logical argument that the influencing agent can present, either directly or indirectly, to the target in order to implement change” (p. 152). ogy, 78(6), 952-963. Michael, N.L. (2010). Oral preexposure prophylaxis for HIV – Another arrow in the quiver? [Editorial]. New England Journal of Medicine, 363(27), 2663-2665. Naar-King, S., Outlaw, A., Green-Jones, M., Wright, K., & Parsons, J.T. (2009). Motivational interviewing by peer outreach workers: A pilot randomized clinical trial to retain adolescents and young adults in HIV care. AIDS Care, 21(7), 868-873. Patel, V., Weiss, H.A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., De Silva, M.J., Bhat, B., Araya, R., King, M., Simon, G., Verdeli, H., & Kirkwood, B.R. (2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): A cluster randomised controlled trial. Lancet, 376(9758), 2086-2095. Raja, S., McKirnan, D., & Glick, N. (2007). The Treatment Advocacy Program-Sinai: A peer-based HIV prevention intervention for working with African American HIVinfected persons. AIDS & Behavior, 11 (Suppl. 1), 127-137. Relf, M.V., Mekwa, J., Chasokela, C., Nhlengethwa, W., Letsie, E., Mtengezo, J., Ramantele, K., Diesel, T., Booth, C., Deng, L., Mallinson, R.K., Powell, D., Webb, A., Liddle, A., Yu-Shears, J., Hall, C., Aranda-Naranjo, B., & Hopson, D.P. (2011). Essential nursing competencies related to HIV and AIDS. Journal of the Association of Nurses in AIDS Care, 22 (1 Suppl. 1), e5-e40. Ross, D.A. (2010). Behavioural interventions to reduce HIV risk: What works? AIDS, 24(Suppl. 4), S4-S14. Selke, H.M., Kimaiyo, S., Sidle, J.E., Vedanthan, R., Tierney, W.M., Shen, C., Denski, C.D., Katschke, A.R., & Wools- Kaloustian, K. (2010). Task-shifting of antiretroviral delivery from health care workers to persons living with HIV/AIDS: Clinical outcomes of a community-based program in Kenya. Journal of Acquired Immune Deficiency Syndromes, 55(4), 483-490. —— Compiled by Abraham Feingold, Psy.D. mental health AIDS, Volume 12(3), Spring 2011-------------------------------------------Page 7
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